Lymphoedema Evidence Library › Topics › Services in South Africa
Services in South Africa
Services and the South African context
88 sources
Evidence in one minute
- LAOSA (founded 2012) certifies therapists with at least 135 hours of training and keeps a national register. Its 2018 position statement sets out definitions, staging, diagnosis, CDT, compression classes, contraindications and surgery for SA, and argues for Prescribed Minimum Benefit status. Davey 2018
- Workforce: about 67 certified therapists in 2014, fewer than 10% in the public sector. In 2023 only 38% of 402 responding physiotherapists treated lymphoedema; 16% of those had certified training and 31% offered full CDT (self-selected 5% sample). Marco 2014 · Rhodes 2023
- Burden: no SA population prevalence study exists. The 530 000–1.06 million estimate extrapolates an uncited "WHO 2014" figure — do not quote it as data (revised 2026-10-09). The first SA figure: 29.7% of 155 Johannesburg women had a ≥200 mL leg difference 1–2 years after pelvic radiotherapy, nearly all mild (very low; probably an overestimate). Davey 2014 · Khutjwe 2020
- Models that suit scarce therapist time: garments first, taught self-CDT, self-care training and a good leaflet each match more intensive care in trials (low to moderate). Jeffs 2024 · Gultekin 2025 · Douglass 2016 · Ridner 2020
- Guidelines are weak: only four lymphoedema guidelines qualified and all scored low on AGREE II (CREST best, 67%), which supports writing an evidence-based local guideline. O'Donnell TF Jr 2020 · O'Donnell TF Jr 2020
- Trial results may not transfer: only 14% of recent lymphoedema trials report race, and about 7% of participants are Black. Escobar-Domingo 2023
- Malignant lymphoedema red flags need urgent oncology review: abrupt onset, pain, proximal start and collateral veins. Forner-Cordero 2022
South Africa
- Practice realities: no official BCRL guideline; garments and bandages rarely available in public hospitals; medical aids pay little; garments made locally, often without a measured pressure; long custom lead times; adherence problems; cellulitis admissions. The proposed pathway measures every newly diagnosed breast cancer patient before treatment and sends symptomatic patients at clinics to trained staff and home-based carers. Marco 2014 · Vivian 2019
- Appraisal of SA opinion pieces (JBI): Marco 2014 4/6 (workforce figure from LAOSA, not a survey; staging non-standard); Davey 2014 3/6 (the author founded LAOSA, which the article promotes).
- Hospital frequency: lymphoedema was 0.05% of Baragwanath (1970) and 0.14% of Ga-Rankuwa (1982) dermatology referrals. Dogliotti 1970 · Schulz 1982
- History: CDT reached SA physiotherapy by 1986 and was promoted to doctors in 1992 with benzopyrones (claims since disproved); the first LANA-standard course ran at UWC, Cape Town, in 2008 (22 therapists); historic SA surgical literature on lymphangiography and secondary lymphoedema (citation only). Goodenough 1986 · Casley-Smith 1992 · Stout 2009 · Abramowitz 1970
- Culture: traditional healers, consulted by about 80% of South Africans, refer some patients to clinics; the stigma of cancer is strong. Dine 2009
- HIV and Kaposi sarcoma: Kaposi lymphoedema with popliteal HIV thrombosis and gangrene in a 34-year-old Durban man is a local differential; lymphovenous bypass helped one CDT-refractory Kaposi case. Ebrahim 2009 · Jimenez 2022
- Mayrovitz–Davey research (Florida, 2005–2014): Suzi (Humen) Davey, later on the LAOSA position-statement panel and based in Hillcrest, KwaZulu-Natal, co-authored the tissue dielectric constant and pneumatic compression studies. Mayrovitz 2014 · Fife 2012
Africa and other low-resource settings
- Burden: arm lymphoedema prevalence about 27% after breast cancer treatment in LMICs (no SA cohort); in Ghana, recorded BCRL was 9.9% (ALND 19% v 8%), mostly in late-stage disease, with return-to-work difficulties. Torgbenu 2020 · Sekyere 2019 · Anderson 2024
- Rural residence raises the risk of chronic BCRL (PREVENT). Boyages 2023 · Koelmeyer 2022
- Low-cost compression: AMPATH (Kenya) makes two-layer zinc-paste bandages for about US$2 per leg per week v US$7–20 imported; patients preferred home or group bandaging to weekly clinic travel. Effect unproven (pilot). Chang 2022
- Low-resource best practice has been adapted; no BCRL questionnaire is validated for indigenous groups or hot climates; an Egyptian trial found VR and PNF exercise equally effective (very low). Keast 2025 · Gordon 2009 · Atef 2020
Service models and delivery
- Templates: the UK Lymphoedema Framework service template; the Dutch expert-centre chronic-care model; the Canadian Lymphedema Framework with accredited online training; a Northern Ireland managed clinical network; ALFP care models and economics; a minimum service dataset is feasible; a funding-case template. Lymphoedema Framework 2007 · International Lymphoedema Framework 2012 · Canadian Lymphedema Framework 2023 · Rankin 2010 · Stout 2013 · Woods 2021 · Bulley 2007
- Swedish practice: early education and measurement after node surgery, compression first, MLD only as a self-massage trial. Nikolaidis 2013
- Remote care: an Iranian self-management app improved QoL and arm circumference over 3 months (180 women) — low; Telegram-channel education showed little effect; Spanish telemedicine triage criteria; a remote service set-up. Hemati 2025 · Omidi 2020 · Forner Cordero I 2020 · Busick 2025
- Nurse-led and self-care packages: a nurse-taught package with light hosiery halved first-year leg lymphoedema after radical hysterectomy (low); head and neck self-management teaching looked effective. Wang 2020 · Deng 2025
- Funding: Japan added CDT to national insurance in 2016, an advocacy model for SA schemes. LVA was not cost-effective from a Dutch health-service view. Wagner 2017 · Kleeven 2026
Low-resource vascular surgery
- Neglected tropical diseases cause vascular as well as lymphatic disease (schistosomal and hydatid caval involvement, mycotic aneurysms, tungiasis worsening limb ischaemia, snakebite), while non-communicable vascular disease rises in LMICs with poor access and no registries. Silvestri 2024
Patient information
- Most UK cancer patients were not warned about lymphoedema (1 449 surveyed); patients forget education within months, so repeat it; keep it brief, repeated and with a named contact. Online information is poor (median EQIP 22/36; 75% omit risks). Lam 2006 · Lemcke 2022 · Perdomo 2023 · Kok 2026
- Myths to correct (observational evidence, low certainty): blood pressure cuffs, venepuncture, air travel and exercise have not been shown to cause or worsen lymphoedema, and heat exposure has not been shown to cause it (though heat can worsen existing swelling); no diet helps apart from weight control; diuretics do not help. Older patient books still advise these precautions. Greene 2015 · Thiadens 2010 · Woods 2007
- Psychosocial support is barely studied; hybrid clinic-plus-remote care looks best. Stolker 2026
Prevalence proxies and palliative care
- Death certificates 2–5 per 10 000; treated caseload 1.5 per 1 000 (West Midlands); oedema in 28.5% of hospice patients; subcutaneous needle drainage for end-of-life oedema. Grigorean 2023 · Cooper 2013 · Huor 2021 · Landers 2017
For the therapist
- Do: teach self-management early and repeat it; use low-cost options with trial support (off-the-shelf sleeves, self-bandaging at night, supervised strength training); measure and record garment pressures where possible.
- Advocate: use the motivation points in the compression topic (garment replacement about every 6 months) and the PMB argument in the LAOSA statement.
- Research gaps therapists could fill: SA prevalence, costs and outcomes; questionnaires validated in SA languages; measured pressures of locally made garments; flat- v circular-knit comparison.
Gaps and warnings
- No SA epidemiology, cost or outcome data; no SA guideline on surgery; LAOSA's planned consensus document (2018) is not held.
How the evidence points
| High | Mod. | Low | V. low | None | |
|---|---|---|---|---|---|
| Positive | 0 | 0 | 4 | 0 | 0 |
| Null or negative | 0 | 1 | 2 | 3 | 0 |
Sources on this page with a comparison, by the result of their primary outcome and the GRADE certainty of their main finding (Mod. = Moderate, V. low = Very low, None = not graded). Context sources are not counted. How direction is decided.
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